What form would this new medical knowledge now that the elision of theory resulted in the conflation of instruction and practice?
Embedded within the notion of the immediately practicable and observable knowledge is the lingering element of theory and history: the practice of recording the individual case. Through the modification that the recording of cases makes to the practical training of medicine, the "proto-clinic" (p. 58) begins to emerge, which Foucault describes as:
"This proto-clinic is more than a successive, collective study of cases: it must gather together and make perceptible the organized corpus of nosology...Its task is not to indicate individual cses, with their dramatic points and their particular characteristics, but to manifest the complete circle of the disease...Before being a meeting of patient and doctor, a truth to be deciphered and an ignorance, and in order to be such a meeting, the clinic must form, constitutionally, a structured nosological field." (p. 59)
In order to be an applicable and complete means of practice, clinical case studies must establish a unified and structured framework of practice:
"[I]n the hospital one is dealing with individuals who happen to be suffering from one disease or another; the role of the hospital doctor is to discover the disease in the patient; and this interiority of the disease means that it is often buried in the patient, concealed within him like a cryptogram. In the clinic, on the other hand, one is dealing with diseases that happen to be afflicting this or that patient: what is present is the disease itself, in the body that is appropriate to it, which is not that of the patient, but that of its truth. It is 'the different diseases that serve as the text': the patient is only that through which the text can be read, in what is sometimes a complicated and confusing state. In the hospital, the patient is the subject of his disease, that is, he is a case, in the clinic, where on is dealing with examples, the patient is the accident of his disease, the transitory object that it happens to have seized upon...The clinic knows its truth, therefore, only in its synthetic form." (p. 59)
The "synthetic form" is that in the clinical, nosological framework, there occurs a synthethis between the examination of the patient and the nosological system which guides that examination as to what to look for. Since the doctor can only operate within the system, the final act of diagnosis is not one of new discovery, but one of synthesis that realizes its end in the naming of the disease, from which a list of therapeutic steps will follow.
"In other words, the gaze that traverses a sick body attains the truth that it seeks only by passing through the dogmatic stage of the name, in which a double truth is contained: the hidden, but already present truth of the disease and the enclosed truth that is clearly deducible from the outcome and from the means. So it is not the gaze itself that has the power of analysis and synthesis, but the synthetic truth of language, which is added from the outside, as a reward for the vigilant gaze of the student. In this clinical method, in which the density of the perceived hides only the imperious and laconic truth that names, it is a question not of an examination, but of a deciphering." (p. 60)
Thus, the clinic cannot be a source of new knowledge, but only a vehicle of transmission and application of old knowledge:
"The clinic was concerned only with the instruction, in the narrow sense of the word, that is given by a master to his pupils. It was not in itself an experience, but a condensed version, for the use of others, of previous experience...In no sense was the clinic to discover by means of the gaze; it merely duplicated the are of demonstrating by showing." (p. 61)
As such, the new practice of the proto-clinic was self-limiting in its medical scope:
"[Proto-clinical practice] did not prove to be of great value in the actual movement of scientific knowledge; it formed a marginal structure that was articulated upon the hospital field without having the same configuration; it was intended as a means of teaching medical practice, which it symbolized rather than analysed; it grouped all experience around the play of a verbal unmasking that was not simply its form of transmission, theatrically retarded...But in a few years, the last years of the century, the clinic was to undergo a sudden, radical restructuring: detached from the theoretical context in which it was born, it was to be given a field of application that was no longer confined to that in which knowledge was said, but which was co-extensive with that in which it was born, put to the test, and fulfilled itself: it was to be identified with the whole of medical experience. For this, it had to be armed with new powers, detached from the language on the basis of which it had been offered as a lesson, and freed for the movement of discovery." (p. 62)
